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Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intuba...

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Autores principales: Arrivé, François, Coudroy, Rémi, Thille, Arnaud W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700413/
https://www.ncbi.nlm.nih.gov/pubmed/34943543
http://dx.doi.org/10.3390/diagnostics11122307
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author Arrivé, François
Coudroy, Rémi
Thille, Arnaud W.
author_facet Arrivé, François
Coudroy, Rémi
Thille, Arnaud W.
author_sort Arrivé, François
collection PubMed
description Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.
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spelling pubmed-87004132021-12-24 Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS) Arrivé, François Coudroy, Rémi Thille, Arnaud W. Diagnostics (Basel) Review Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up. MDPI 2021-12-08 /pmc/articles/PMC8700413/ /pubmed/34943543 http://dx.doi.org/10.3390/diagnostics11122307 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Arrivé, François
Coudroy, Rémi
Thille, Arnaud W.
Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title_full Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title_fullStr Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title_full_unstemmed Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title_short Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)
title_sort early identification and diagnostic approach in acute respiratory distress syndrome (ards)
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700413/
https://www.ncbi.nlm.nih.gov/pubmed/34943543
http://dx.doi.org/10.3390/diagnostics11122307
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